Provider Demographics
NPI:1427151745
Name:PHELPS, ZACHARY A (MD)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:A
Last Name:PHELPS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COUPEVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98239-3413
Mailing Address - Country:US
Mailing Address - Phone:360-678-7609
Mailing Address - Fax:
Practice Address - Street 1:101 N MAIN ST
Practice Address - Street 2:
Practice Address - City:COUPEVILLE
Practice Address - State:WA
Practice Address - Zip Code:98239-3413
Practice Address - Country:US
Practice Address - Phone:360-678-7609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60050731207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJDO79899OtherSTATE NARCOTICS LICENSE
NJMA72279OtherMEDICAL LICENSE
NJ8565104Medicaid
NJBP7356517OtherDEA
NJDO79899OtherSTATE NARCOTICS LICENSE
H44818Medicare UPIN